Acute Appendicitis

Overview

Acute appendicitis is an inflammation of the appendix. It is one of the most common surgical emergencies.

Symptoms

 

Symptoms of acute appendicitis can vary widely from person to person. This is more so in young children, pregnant women and elderly patients, where symptoms can be atypical. Classical symptoms of appendicitis are abdominal pain at the lower right side of the abdomen, or pain originating from the upper part of the abdomen or the centre part near the belly button, before the pain migrates to the right side. The person may also experience fever, nausea and/or vomiting, diarrhoea, abdominal bloating and loss of appetite.

When to seek treatment

Appendicitis is considered an emergency, as delayed treatment can result in perforation of the appendix. With infection of the appendix, the appendix swells up, sometimes to a point that the appendix burst a hole, allowing faeces to leak from the intestine into the abdomen. When this happens, the person can become very ill from severe infection. This is known as septicaemia, a condition where is there bacterial infection of the blood. Some people call this “blood poisoning”. There is a possibility of death from this severe infection.

Therefore if the person experience abdominal pain which persists for more than a few hours, or which worsens with time, he should seek medical attention soonest possible.

acute appendicitis

Diagnosis

The doctor will take a detailed history and examined the abdomen. Tell-tale sign includes localized tenderness at the right lower quadrant of the abdomen. The person will “guard” his abdomen when the doctor attempts to press down on the abdomen. He may also have fever.

The doctor will usually order some blood test and a CT scan to confirm the diagnosis. The doctor will look out for an increase in the white blood cells, suggesting some form of infection. A CT scan has an accuracy rate of 98% in diagnosing acute appendicitis.

Treatment

The best form of treatment for appendicitis is surgery. This is known as an appendicectomy – the operation to remove the appendix. Appendicectomy can be performed by the conventional open method, with a scar at the right lower quadrant of the abdomen, or via a minimally invasive laparoscopic approach. Laparoscopic surgery is also called keyhole surgery where the surgeon uses a few small holes between 5mm to 1cm to perform the operation.

The laparoscopic technique is now the preferred option due to the smaller scars and the faster recovery.

In selected persons, appendicitis can also be treated with antibiotics alone. However, there is a risk of appendicitis occurring again. Your doctor will discuss with you the pros and cons of these options.

Causes

It is widely believed that acute appendicitis occurs as a result of blockage of the lumen of the appendix. This blockage can be due to faeces, a growth, foreign bodies or infection.

Risk Factors

Many children would have grown up having their parents warned them not to run around after a meal as that would cause appendicitis.

There is as yet no scientific proof for this. Nonetheless, it is advisable not to exercise immediately after a meal, as that may cause stomach discomfort and nausea.

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